Upper Gastro

by Dr Ooi Wei Keong
Consultant General Surgeon M.D. (UKM), M.S.(GENERAL SURGEON UKM)

It is a condition whereby there is MASSIVE bleeding from GastroIntestinal tract, the bleeding source can be anywhere from mouth to ligament of Treitz (The transition point between duodenum and jejunum).

Bleeding from any point between the 2 Red spots shown is defined as Upper Gastro-Intestinal bleed:

Why is UGIH a Dangerous Condition?
Uncontrolled bleeding potentially crashes a patient’s blood pressure [Haemodynamic status]. It is therefore a potentially Lifethreatening condition.

What are the common causes of UGIB/UGIH?
Cancers – Oesophageal cancers, Stomach cancers, Peptic Ulceration, Oesophageal variceal that is commonly seen in patient with Liver cirrhosis [from Alcoholism or Viral Hepatitis]

How do patients with UGIB/UGIH manifest?
A patient with UGIH may just come with Anaemia [Low Haemglobin] if the bleeding is slow and minimal. However if the bleeding is profuse, one may have Hemetemesis [Vomiting of blood] or Passing Black tarry stool [The Faeces look as black as a Tarred Road]

Some patient may even present with Fresh blood in stool [Haematochezia] if the bleeding is uncontrolled.

The patient may also experience fainting spell and low blood pressure [Hypovolaemic Shock], a potentially life threatening condition.

Why does the stool turn into Black tarry colour in UGIB/UGIH?
Blood from the Upper gastrointestinal tract will be digested as it passes down the tract, the Iron in the blood is metabolised and changes the colour from red to tarry black. However in the case of massive bleed, the digestion of blood is not fast enough against the bleeding rate, one may still pass out flesh blood [Haematochezia]

What will the doctor do if a patient comes with UGIH?
Depending on the patient’s manifestation and haemodynamic status, a Haemodynamic Unstable Patient will need Urgent fluid/ blood resuscitation and perhaps an Emergency OGDS [Oesophageaduodeno-scopy] to identify the site of bleeding, with the aim to stop the bleeding Endoscopically.

A bleeding Peptic Ulcer usually responds to the combination of Endoscopic treatment and Infusion Proton Pump Inhibitor. Failing that, the Surgeon may need to perform an Emergency Surgery to manually stop the bleeding.

What is OGDS
OGDS – Oesophagea-Duodeno-Scope is a form of Fiberoptic instrument that allows the user to enter & visualise the patient’s digestive tract without having to open the abdominal wall. It is a Diagnostic and Therapeutic equipment [To locate site of bleeding and To stop the bleeding]

What is a Proton Pump Inhibitor?
In the case of UGIH secondary to Peptic Ulceration, the doctor will prescribe Infusion Proton Pump Inhibitor to the Patient for 72 hours.

Its main function is to lower the Acidity of Stomach hence allowing any possible clot to remain stable, hence prevent further bleeding.

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